Case 14-1973

Presentation of Case First admission. An 81-year-old woman was admitted to the hospital because of anemia.She was well and vigorous until three years previously, when anorexia developed after the death of her husband, with gradual loss of 30 kg in weight. Three months before entry she began to experience fatigue, dizziness and gradually progressive exertional dyspnea. For several weeks before admission dyspnea and chest pain occurred on walking across a room, with three-pillow orthopnea. Ten days before entry a physician prescribed iron and digoxin, without benefit.There was no history of prior chest pain, edema, anemia, bleeding or bruising, . . .